Why did the GOP have such a hard time repealing and replacing Obamacare?

You would think that after voting more than sixty times to repeal or roll back parts of Obamacare, it would finally happen now that Republicans control both chambers of Congress and the White House. But this week, the Republicans had real trouble getting enough votes, despite having campaigned on this for the past three electioncycles, and in spite of the fact that President Trump made this a make or break vote. Ultimately, they could not muster the votes to pass the American Health Care Act (AHCA), leaving the Affordable Care Act in place and the future of the Republican leadership uncertain.

Why did they fail?

With the help of data generated by Brookings, the Cook Political Report, and the Center for American Progress, we put together the following table. It lists all thirty-two members of Congress who, as of Friday morning (the day the vote was supposed to take place), were listed by the Washington Post as voting against the AHCA.

The first data column lists the margin by which the incumbent congressperson won his or her last election. The average margin for these Republicans was 24 percent and the median was 22 percent. Only four of the probable no votes won with less than 10 percent of the vote and three won with more than 40 percent of the vote. (Two were unopposed.) By and large, these members come from very solidly Republican districts. They are not afraid of losing to a Democrat in a general election, but they could lose to an ideologically hard-right Republican challenger in a primary. Hence their hard-line position on the health care bill.

The second column is data taken from one of the most respected and utilized measures in American politics, the Cook Partisan Voting Index—the PVI for short. This is a measure that uses past voting behavior to analyze how Democratic or how Republican a congressional district is compared to the nation as a whole. Among the potential no votes, only one member’s district has a Democratic tilt. And only five districts have a Republican edge under five. The PVI reinforces the fact that these are safe Republican districts where the only threat to a member’s re-election is a primary threat.

The third column lists the margin of the presidential vote in each of these members’ districts that went to Donald Trump. Hillary Clinton only won three out of the 32 listed. In four others Donald Trump won by less than five percent. But in most of these districts, Trump won by large margins. The average Trump victory was 18 percent and the median was around 13 percent. In spite of his troubles across the country, Trump is still holding on to popularity in the Republican base. Because Trump captured the nomination from the top, not from the grass roots, he does not have the kind of organization that could mount primary challenges. Clearly few of these members feared the wrath of their president come primary time. More likely, they feared the Koch brothers who threatened to defeat anyone who voted against the president’s bill.

The fourth and fifth columns are taken from work done by David Cutler and Emily Gee for the Center for American Progress (CAP). Taking the Congressional Budget Office score of anticipated losses in health care coverage under the Republican bill, they combined census data, data from the Kaiser Family Foundation, and data from the Centers for Medicare and Medicaid Services to come up with estimates showing how many people in each congressional district would lose health care coverage under the Republican bill. The “CAP Losses” shows estimated losses in absolute numbers and the “CAP Rank” column shows where the congressional district ranks compared to all the other districts in the country.

Since there are 435 districts, those who are ranked below 217 will suffer higher losses in health insurance coverage than those ranked above 217. Among those inclined to vote no the potential losses were split somewhat evenly. There are 17 congressional districts in the bottom half of coverage losses and 20 districts in the top half of losses in coverage. One would expect that the fewer in their district who would lose insurance, the more likely the member of Congress would feel comfortable in holding to an ideologically pure position.

The final column is drawn from our research for The Primaries Project 2016, showing the candidate’s position on the Affordable Care Act during the 2016 election. The majority of the wavering candidates—23 of the 32—were explicitly opposed to Obamacare during their 2016 primaries. As our research on congressional primaries shows, Republican congressional candidates campaigned mostly on tax cuts and repeal of Obamacare. This also reinforces the conclusion that these wavering Republicans are concerned about “getting primaried” because they supported a bill that does not (in their eyes) repeal Obamacare.

President Trump is not the first president to find out how hard it is to pass legislation when a determined faction of your party is opposed to it. And he certainly won’t be the last. But he will likely be the first to unleash a Twitter storm. Stay tuned.

Republicans Members of Congress Opposing the AHCA

Incumbent

District

2016 Margin

PVI

Trump Margin

CAP Value

CAP Rank

Primaries position on ACA

Ileana Ros-Lehtinen

FL-27

9.80%

D+9

-19.7

81300

25

Oppose

Leonard Lance

NJ-7

11%

R+ 1

-1.1

35200

421

Oppose

Rod Blum

IA-1

7.70%

R+ 3

3.5

41100

351

Oppose

David Young

IA-3

13.70%

R+ 3

3.5

45400

286

Oppose

Frank LoBiondo

NJ-2

22%

R+ 4

4.6

43900

307

None

Dave Brat

VA-7

15.30%

R+ 5

6.5

49700

241

Oppose

Charles W. Dent

PA-15

20.40%

R+ 5

7.6

42200

332

Oppose

Jaime Herrera Beutler

WA-3

23.50%

R+ 5

7.4

42600

325

None

Daniel Donovan

NY-11

24.90%

R+ 6

9.8

82100

23

Oppose

Brian Fitzpatrick

PA-8

9%

R+1

0.2

37800

398

None

Andy Biggs

AZ-5

28.20%

R+12

-2.1

40700

81

Oppose

Bill Posey

FL-8

30.60%

R+12

20.7

57900

166

Oppose

Scott Perry

PA-4

32.10%

R+12

21.5

42500

327

Oppose

Walter B. Jones

NC-3

34.40%

R+13

23.6

70400

66

Oppose

Jody Hice

GA-10

U

R+14

25.5

61500

139

Oppose

Mark Meadows

NC-11

28.20%

R+16

29.4

76900

40

Oppose

Mo Brooks

AL-5

33.50%

R+18

33.6

61400

141

None

Jim Jordan

OH-4

6%

R+19

33.6

39900

364

None

Warren Davidson

OH-8

41.80%

R+19

34.5

39500

372

Oppose

Eric A. “Rick” Crawford

AK-1

U

R+19

34.8

51000

224

None

Thomas Massie

KY-4

42.60%

R+20

35.9

42700

324

Oppose

Raúl R. Labrador

ID-1

36.40%

R+23

38.3

67400

83

Oppose

Louie Gohmert

TX-1

49.80%

R+25

46.9

63700

112

Oppose

Ted Budd

NC-13

12.20%

R+6

9.4

77300

38

Oppose

Justin Amash

MI-3

22%

R+6

9.4

43600

314

None

Thomas Garrett

VA-5

16.60%

R+7

11.1

55700

182

Oppose

Mark Amodei

NV-2

21.40%

R+8

12.3

37500

407

None

Mark Sanford

SC-1

21.80%

R+8

13.1

56600

175

Oppose

Rob Wittman

VA-1

23.30%

R+8

12.4

45600

282

Oppose

Don Young

AK-1

14.30%

R+9

15.2

44500

295

Oppose

Ted Yoho

FL-3

16.80%

R+9

16

64200

106

Oppose

Chris Smith

NJ-4

30.20%

R+9

14.8

39100

380

None

Sources: Brookings, Cook Political Report, Center for American Progress